Causes Of Health Disparities Research Articles

Improving Black Maternal Health: Early Implementation Findings from California's Black Infant Health Program.

This paper reviews the scientific basis and reports initial implementation results of California's Black Infant Health Program, a statewide group-based program with complementary one-on-one life planning to improve maternal and infant health among Black mothers and birthing persons. Descriptive analyses were conducted at the participant and group session level using program evaluation data from the initial three years of program implementation to examine participation rates, rates of service delivery, and participants perceptions of the program. From 2015 to 2018, 3332 Black birthing persons received group and/or life planning and 386 10-session prenatal group series were initiated with an average of 5.9 participants per series. Most sessions delivered all required activities (86.1%) and met requirements for providing food (84.5%), transportation support (72.2%), and childcare (55.4%). More than 90% of responding participants agreed or strongly agreed that BIH helped them manage stress (94.5%), set (97.4%) and achieve (92.9%) goals, and build stronger social connections (94.5%). The program was developed in response to evolving scientific knowledge regarding racism as the root cause of health disparities for Black birthing people. Focusing on six interwoven strategies for improving maternal and infant health outcomes, the program is supported by current scientific knowledge and can be feasibly implemented at a level consistent with similar evidence-based models.

Native HeArts: Digital Storytelling Through Indigenous Art

ABSTRACT Health disparities for Native/Indigenous youth are perpetuated by systemic bias and racism. Both the scientific literature and media play a role in maintaining disparities by telling stories through narrative or numbers that invalidate Indigenous knowledge and ways of systematic investigation, intervention, and communication regarding health and well-being. Youth were mentored by Indigenous artists to develop culturally relevant digital stories that speak to community wellness efforts, strengths, and resilience in regard to substance abuse and suicide prevention (from youth perspectives) to target root causes of health disparities by shifting narrative power to decolonial Indigenous philosophies. Together, we developed an intervention that targets the underlying root causes of health disparities by transforming the very structures upon which health interventions hinge. The realm of communication is one of these structures that is ripe with possibilities for new conceptions that uplift strength-based narratives through digital media. We created an intervention that emphasizes possibilities through positive images of Indigenous people, effectively addressing community issues by building community-based narrative power.

Differences in Physical Activity and Self-Rated Health Levels Based on Satisfaction with Physical Environment of Local Communities: From School to Lifelong Physical Education.

In Korea, substantial disparities exist in physical environments across regions, exacerbating the polarization between metropolitan and provincial areas and urban and rural regions. This study examines the differences in the physical activity and self-rated health of local communities in relation to satisfaction with the physical environment. By identifying and addressing these underlying causes of health disparities, the study provides foundational data to inform policy efforts. The study utilized data from the 2023 Community Health Survey conducted by the Korea Disease Control and Prevention Agency. It included 231,752 individuals aged 19 and older (105,754 men and 125,998 women) selected through a two-stage probability proportional systematic sampling method. One-on-one online interviews were conducted from 16 May to 31 July 2023. The physical environment was assessed based on public satisfaction with safety, natural and living environments, public transportation, and medical services. Study variables included subjective health status and physical activity, with subvariables for physical activity encompassing the duration of vigorous and moderate physical activity, walking, and flexibility exercises. For data analysis, MANOVA and ANOVA were conducted, with Bonferroni correction for multiple comparisons. Considerable variations in physical activity were observed based on satisfaction with the local community environment. Regarding self-rated health, significant differences were found in safety levels, living environment, and medical services. Satisfaction with the physical environment positively influenced physical activity and self-rated health. Therefore, it is imperative to reduce disparities in the physical environment between regions and enhance residents' satisfaction.

Social determinants of health analysis makes causal inference and requires analytic epidemiology methods

The growing emphasis on reducing health disparities and addressing social determinants of health (SDH) has prompted many national and local health agencies to report population health data by SDH measures. However, many agencies rely on descriptive epidemiology methods for such reports and are susceptible to biased findings due to inadequate confounding control. In this brief analytic essay, using the data presented in an HIV Surveillance Report by the Centers for Disease Control and Prevention (CDC), we demonstrated an example of how reporting health outcomes by SDH with descriptive methods could bias the results and conclusions. SDH are causes of health disparities and SDH analysis requires analytic epidemiology methods to ensure valid research results and effective interventions.

Structural Racism and Obesity-Related Cancer Inequities in the United States: Challenges and Research Priorities.

Structural racism has been identified as a fundamental cause of health disparities. For example, racial, ethnic, and economic neighborhood segregation; concentrated poverty; community disinvestment; and sociocultural context influence obesity and cancer disparities. Effects of structural racism are also evident through neighborhood obesogenic conditions such as limited access to affordable and healthy foods and physical activity opportunities within segregated communities that contribute to obesity and obesity-related cancer disparities. This article describes and expands on cross-cutting themes raised during a webinar held by the National Cancer Institute (NCI): (1) how structural factors, including neighborhood segregation and obesogenic conditions within racial and ethnic disadvantaged communities, influence disparities in the United States; (2) current research challenges and best ways to address them; and (3) selected priorities of the NCI aimed at addressing multilevel and intersecting factors that influence obesity-related cancer disparities. Further research is needed to understand how residential segregation and neighborhood obesogenic conditions influence cancer prevention and control across the continuum. Identifying the best approaches to address obesity and cancer disparities using social determinants of health framework and community-engaged approaches guided by a structural racism lens will allow researchers to move beyond individual-level approaches.

Nursing leadership in tobacco dependence treatment to advance health equity: An American Academy of Nursing policy manuscript

BackgroundTobacco use remains the leading cause of preventable disease, disability, and death in the United States and is a significant cause of health disparities. PurposeThe purpose of this paper is to update the Tobacco Control policy paper published over a decade ago by the American Academy of Nursing’s Health Behavior Expert Panel Tobacco Control subcommittee. MethodsMembers reviewed and synthesized published literature from 2012 to 2024 to identify the current state of the science related to nurse-led tobacco dependence treatment and implications for nursing practice, education, and research. FindingsThe results confirmed that nurse-led tobacco dependence treatment interventions are successful in enhancing cessation outcomes across settings. DiscussionRecommendations for nursing leaders include: promote tobacco dependence treatment as standard care, accelerate research on implementation of evidence-based treatment guidelines, reduce health disparities by extending access to evidence-based treatment, increase nursing competency in providing tobacco treatment, and drive equity-focused tobacco control policies.

Diversity and scale: Genetic architecture of 2068 traits in the VA Million Veteran Program.

One of the justifiable criticisms of human genetic studies is the underrepresentation of participants from diverse populations. Lack of inclusion must be addressed at-scale to identify causal disease factors and understand the genetic causes of health disparities. We present genome-wide associations for 2068 traits from 635,969 participants in the Department of Veterans Affairs Million Veteran Program, a longitudinal study of diverse United States Veterans. Systematic analysis revealed 13,672 genomic risk loci; 1608 were only significant after including non-European populations. Fine-mapping identified causal variants at 6318 signals across 613 traits. One-third (n = 2069) were identified in participants from non-European populations. This reveals a broadly similar genetic architecture across populations, highlights genetic insights gained from underrepresented groups, and presents an extensive atlas of genetic associations.

Polygenic and Socioeconomic Contributions to Nicotine Use and Cardiometabolic Health in Early Mid-Life.

Early mid-life is marked by accumulating risks for cardiometabolic illness linked to health-risk behaviors like nicotine use. Identifying polygenic indices (PGI) has enriched scientific understanding of the cumulative genetic contributions to behavioral and cardiometabolic health, though few studies have assessed these associations alongside socioeconomic (SES) and lifestyle factors. Drawing on data from 2337 individuals from the United States participating in the National Longitudinal Study of Adolescent to Adult Health, the current study assesses the fraction of variance in five related outcomes-use of conventional and electronic cigarettes, body mass index (BMI), waist circumference, and glycosylated hemoglobin (A1c)-explained by PGI, SES, and lifestyle. Regression models on African ancestry (AA) and European ancestry (EA) subsamples reveal that the fraction of variance explained by PGI ranges across outcomes. While adjusting for sex and age, PGI explained 3.5%, 2.2%, and 0% in the AA subsample of variability in BMI, waist circumference, and A1c, respectively (in the EA subsample these figures were 7.7%, 9.4%, and 1.3%). The proportion of variance explained by PGI in nicotine-use outcomes is also variable. Results further indicate that PGI and SES are generally complementary, accounting for more variance in the outcomes when modeled together versus separately. PGI are gaining attention in population health surveillance, but polygenic variability might not align clearly with health differences in populations or surpass SES as a fundamental cause of health disparities. We discuss future steps in integrating PGI and SES to refine population health prediction rules. Study findings point to the complementary relationship of PGI and socioeconomic indicators in explaining population variance in nicotine outcomes and cardiometabolic wellness. Population health surveillance and prediction rules would benefit from the combination of information from both polygenic and socioeconomic risks. Additionally, the risk for electronic cigarette use among users of conventional cigarettes may have a genetic component tied to the cumulative genetic propensity for heavy smoking. Further research on PGI for vaping is needed.

Diversity, Equity, Inclusion, and Antiracism Research in Physical Therapy Over the Last 25Years: A Scoping Review.

Discussions of the root causes of health disparities and educational inequities often neglect to identify racism as a primary factor. Researchers must take a systems perspective to identify the effects of racism and other forms of systemic oppression on health. It is unclear to what extent this perspective exists in the physical therapy research literature. We conducted a scoping review to quantify and describe the volume of research in physical therapy pertaining to diversity, equity, and inclusion specifically examining race and/or ethnicity and references racism or antiracism. A systematic search of PubMed and Scopus databases for articles published between 1997 and 2021 was conducted. Articles were screened to ensure they were focused exclusively or primarily on physical therapy and used diversity, equity, and inclusion terms in the context of personal identity factors. This resulted in 158 relevant articles. Each was tagged with an article type and personal identity factor focus. A majority of the included articles were descriptive/observational in nature. The included articles explored various personal identity factors, with race and ethnicity being the most common focus followed by culture, disability, and socioeconomic status. A small proportion of articles explicitly discussed racism or antiracism. These findings highlight the need in physical therapy research for greater attention to racism as a fundamental cause of health disparities and educational inequities. Addressing this gap is crucial for promoting diversity, equity, and inclusion within the field and ultimately achieving optimal health outcomes for marginalized populations. Including consideration of racism and other forms of systemic oppression in the motivation, design, and interpretation of research in physical therapy will help to make more visible the root causes of inequity and improve our ability to develop effective, multi-level interventions.

Hospital racial composition and outcomes after transcatheter and surgical aortic valve replacement.

Key points Racial/ethnic cardiovascular disparities have been demonstrated in optimal cardiovascular health. Racial residential segregation may be a cause of disparities in health. Early outcomes after aortic valve replacement are worse in hospitals treating a larger proportion of non‐White patients.

Human Freedom from Algorithmic Bias: What is the role of Accountability in addressing Health Disparities?

While there are many causes of health disparities, the application of Artificial Intelligence tools in healthcare may have mixed results. The purpose of this paper is to investigate the role of human freedoms and accountability to achieving digital inclusion. It discovers the role of algorithmic bias in mediating the relationship between human freedom and mobile health. The following research questions are investigated: 1) How do human freedoms effect digital inclusion and mobile health? 2) Do human freedoms effect mobile health? And 3) Does AI accountability mediate the relationship between human freedoms and mobile health? The findings suggest that human freedoms are central to digital inclusion and mobile health. Accountability does affect the extent to which digital inclusion can be achieved through human freedoms. AI accountability significantly mediates the relationship between human freedoms and the mobile index. This offers an important contribution in uncovering the role of algorithmic bias in human freedom and mobile health, and of accountability between human freedom and digital inclusion.

Achieving Health Equity and Eliminating Health Disparities Based on Nursing Philosophical, Theoretical and Ethical Perspectives

Background: Nowadays, there has been a growing emphasis on the topic of health equity, which refers to the fundamental principle of addressing and resolving disparities in health outcomes and the factors that influence them, such as social determinants. The pursuit of health equity entails a dedicated effort towards achieving the utmost level of health and wellbeing for every individual, while also paying particular attention to those who are most vulnerable to experiencing poor health due to their social circumstances. Purpose: This paper aimed to delve deeply into the concepts of health equity and disparities in healthcare from nursing perspectives, exploring various philosophies, theories, and ethical principles. Furthermore, it aimed to highlight the crucial role that nursing professionals play in promoting health equity and eradicating health disparities. Methods: A scoping review was conducted to identify relevant international reports and literature published in English, multiple electronic databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, MEDLINE, Google Scholar, SAGE Journals, and PubMed were searched. Results: Nursing professionals have a significant role in achieving health equity and eliminating health disparities. Therefore, there has been a growing emphasis on the importance of achieving health equity, enhancing caring and healing connections as the core of professional nursing, alongside the use of theory-guided practice approaches, and nursing philosophies. Consequently, professionals in the field are actively seeking more practical methods that incorporate a sense of purpose and significance into their work to achieve equity based on essential nursing philosophies and theories. Conclusion: Nurses have a unique and advantageous role in the healthcare system, as they have the ability to make a substantial impact on addressing the underlying factors that contribute to health disparities. Furthermore, nurses work closely with interdisciplinary teams, harnessing the power of collaboration and teamwork to effectively implement a range of strategies aimed at promoting fair and equal access to healthcare for all individuals. Implications for Nursing: Nursing professionals have a crucial role in promoting and maintaining health equity, which has been increasingly recognized and emphasized. In addition, they are in a unique position to lead the way in patient care and can make a significant impact in addressing the underlying causes of health disparities by understanding and acknowledging the various factors that influence a person's health and overall well-being. Keywords: Nursing philosophy, Nursing theories, Ethic principles, Health equity, Health disparities.

Abstract C056: Characterizing the DNA methylome of gastric cancer among Hispanic/Latinos to advance cancer precision health equity

Abstract Gastric cancer (GC) is the second leading cause of cancer-related deaths worldwide. While overall incidence and mortality rates have dropped in recent decades, GC remains a significant cause of health disparities for many racial and ethnic minority groups in the US, including Hispanic/Latino Americans (HLAs). Despite a high minority cancer burden, few FDA-approved targeted therapies are available for GC. This can be partially explained by limited availability of cancer genome data and patient-derived models from racial/ethnic minority populations, hampering therapeutic target identification and drug efficacy studies. Our group has spearheaded the development of the University of California Minority Patient-Derived Xenograft Development and Trial Center (UCaMP) with the goal of addressing these critical issues for GC patient care. Thus far, we have characterized over 30 GC samples from racial/ethnic minorities with more than 60% of samples coming from HLAs. Genomic analyses have revealed a significantly higher prevalence of genomically stable GC (GS-GC) tumors among HLAs compared to TCGA, which is comprised of mostly NLWs. GS-GC is the most aggressive and treatment resistant of the four TCGA-defined molecular subtypes. While we have discovered genomic alterations in several therapeutically targetable pathways among our minority-patient GC tumors, GS-GC tumors remain largely devoid of targetable mutations. These observations have led us to assess the epigenome to inform therapeutic development. We performed reduced representation bisulfite sequencing on 15 GC tumor-adjacent normal pairs from our UCaMP cohort. We identified significantly hyper- and hypomethylated genes and performed overlaps with RNA expression data from TCGA stomach adenocarcinoma cases to identify epigenetically silenced and activated genes unique to each molecular subtype. For GS-GC samples, pathway enrichment analysis revealed significant enrichment of key cancer pathways among silenced genes for GS samples, including WNT/NOTCH, PI3K/Akt, focal adhesions and cell-extracellular matrix interactions, and pro-growth/anti-apoptotic signaling. Importantly, GS samples showed silencing of two PI3K/Akt pathway regulatory subunits, PIK3R2 and PIK3R5, suggesting aberrant signaling of this highly therapeutically targetable pathway despite lack of mutational alterations. This data has provided a basis for further testing of PI3K/Akt targeted inhibitors using our minority patient-derived organoid and xenograft models to treat GS-GC, a GC subtype for which there are currently few effective treatment options and is associated with significant health disparities for Hispanic/Latinos. Citation Format: Nicole B. Halmai, Hongyong Zhang, Paul C. Lott, Ana Estrada-Florez, Ted W. Toal, Javier Torres, UCaMP Consortium, Luis G. Carvajal-Carmona. Characterizing the DNA methylome of gastric cancer among Hispanic/Latinos to advance cancer precision health equity [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C056.

The Impact of Racism on Healthcare Experiences and Well-Being: a Qualitative Study Based on Focus Group Discussions with Communities of Color.

Connections between race and health are discussed, and racism has been called out as a root cause of health disparities. The impacts of systemic racism are not fully understood and should be considered in order to advance health equity. The aim of the study is to explore the impact of racism on healthcare experiences and well-being for communities of color. Individuals from a Northeast region of Wisconsin, who self-identified as Somali, Hmong, Black/African American, Hispanic/Latino/a, and First Nations/Native American/Indigenous, were invited to participate in focus group discussions, and informed consent was obtained from all participants (25 adults, 17 females, and 8 males). Focus groups were planned so participants from the same self-identified communities were together, and five virtual focus group discussions were carried out. A qualitative content analysis approach was used to gain a deeper understanding of the content. There was a range of experiences; however, everyone experienced the negative impacts of racism. Three categories, representing areas impacted by racism, and a final theme, describing the overall impact on healthcare experiences and well-being, were created. Dealing with systemic racism means that "backgrounds and values," "resources," and "prejudices" (categories) require constant attention, maneuvering, and "juggling the impacts of racism diminishes access to healthcare and well-being for communities of color" (theme). Systemic racism negatively impacts access to healthcare and well-being for communities of color perpetuating health disparities. Planning and policy should include a focus on health equity and target systemic racism in order to diminish health disparities.

Unconscious Bias among Health Professionals: A Scoping Review.

Unconscious biases are one of the causes of health disparities. Health professionals have prejudices against patients due to their race, gender, or other factors without their conscious knowledge. This review aimed to provide an overview of research on unconscious bias among health professionals and to investigate the biases that exist in different regions of the world, the health professions that are considered, and the research gaps that still exist. We conducted a scoping review by systematically searching PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and AMED. All records were double-screened and included if they were published between 2011 and 2021. A total of 5186 records were found. After removing duplicates (n = 300), screening titles and abstracts (n = 4210), and full-text screening (n = 695), 87 articles from 81 studies remained. Studies originated from North America (n = 60), Europe (n = 13), and the rest of the world (n = 6), and two studies were of global scope. Racial bias was investigated most frequently (n = 46), followed by gender bias (n = 11), weight bias (n = 10), socio-economic status bias (n = 9), and mental illness bias (n = 7). Most of the studies were conducted by physicians (n = 51) and nurses (n = 20). Other health care professionals were rarely included in these studies. Most studies show that health professionals have an implicit bias. Racial biases among physicians and nurses in the USA are well confirmed. Research is missing on other biases from other regions and other health professions.

Municipal officials' perspectives on policymaking for addressing obesity and health equity.

Obesity evidence-based policies (EBPs) can make a lasting, positive impact on community health; however, policy development and enactment is complex and dependent on multiple forces. This study investigated key factors affecting municipal officials' policymaking for obesity and related health disparities. Semi-structured interviews were conducted with 20 local officials from a selection of municipalities with high obesity or related health disparities across the United States between December 2020 and April 2021. Policymakers follow a general decision-making process with limited distinction between health and other policy areas. Factors affecting policymaking included: being informed about other local, state, and federal policy, conducting their own research using trustworthy sources, and seeking constituent and stakeholder perspectives. Key facilitators included the need for timely, relevant local data, and seeing or hearing from those impacted. Key local policymaking barriers included constituent opposition, misinformation, controversial issues with contentious solutions, and limited understanding of the connection between issues and obesity/health. Policymakers had a range of understanding about causes of health disparities, including views of individual choices, environmental influences on behaviors, and structural factors impacting health. To address health disparities, municipal officials described: a variety of roles policymakers can take, limitations based on the scope of government, challenges with intergovernmental collaboration or across government levels, ability of policymakers and government employees to understand the problem, and the challenge of framing health disparities given the social-political context. Understanding factors affecting the uptake of EBPs can inform local-level interventions that encourage EBP adoption.

Why the Gene Was (Mis)Placed at the Center of American Health Policy

AbstractIn Tyranny of the Gene: Personalized Medicine and Its Threat to Public Health (Knopf, 2023), James Tabery traces the ascendance of personalized or precision medicine in America, arguing that America's emphasis on genetics offers more hype than transformational power. In his examination of the power struggles, social relationships, and technological advances that centered the gene in American health policy, Tabery demonstrates how an intensive focus on genetics draws attention away from both the fundamental causes of health disparities and more‐effective changes that could be made to developmental, physical, and social environments. American policy‐makers, health care institutions, funders, and bioethicists should not let the technological shine and attractive politics of personalized medicine continue to replace the hard but necessary work of addressing sociopolitical causes of disease and illness.

Differences among factors associated with tobacco product use among Black and White adolescents: A cross-sectional analysis of wave one of the PATH study 2013-2014.

Tobacco use remains a primary cause of health disparities between Black and White Americans. Current approaches have not improved tobacco-related racial health disparities. This study aimed to identify differences in factors associated with tobacco product use among Black and White adolescents. This cross-sectional design used data from Wave One (2013-2014) of the Population Assessment of Tobacco and Health Study. Adolescents aged 12-17 years who identified as non-Hispanic Black or African American (n=1800) or non-Hispanic White (n=6495) were included. Primary outcomes were the ever use and current use of any tobacco products. Sociocultural, household environment, psychological, and behavioral factors were included. Logistic regressions, stratified by race, were used to determine significance. Dominance analysis was used to rank significant factors by their level of importance. Although there were many Black-White commonalities, there were also important differences. Black adolescents in the Northeast were more likely to have ever used tobacco compared to those in the South (OR=0.6; 95% CI: 0.6-0.7, p<0.001) and Midwest (OR=0.6; 95% CI: 0.5-0.7, p<0.001). White adolescents in the Northeast were less likely to use tobacco products than in other regions. Peer influences (OR=1.9; 95% CI: 1.1-3.2, p<0.05) were uniquely associated with ever use among Black adolescents. Access to tobacco in the home (OR=2.0; 95% CI: 1.4-3.0, p<0.001) and thinking that tobacco use would help reduce stress (OR=1.3; 95% CI: 1.1-1.6, p<0.01) were uniquely associated with current use among Black adolescents. There are significant Black-White differences in the factors associated with tobacco use. Factors uniquely associated with Black adolescent tobacco use should be considered in developing strategies to prevent adolescent tobacco use in Black communities.

The LSU AgCenter Healthy Communities Initiative: Community-Participatory Policy, Systems, and Environmental Change

The LSU AgCenter Healthy Communities Initiative: Community-Participatory Policy, Systems, and Environmental Change

The structural and social determinants of Alzheimer's disease related dementias.

The projected growth of Alzheimer's disease (AD) and AD-related dementia (ADRD) cases by midcentury has expanded the research field and impelled new lines of inquiry into structural and social determinants of health (S/SDOH) as fundamental drivers of disparities in AD/ADRD. In this review, we employ Bronfenbrenner's ecological systems theory as a framework to posit how S/SDOH impact AD/ADRD risk and outcomes. Bronfenbrenner defined the "macrosystem" as the realm of power (structural) systems that drive S/SDOH and that are the root cause of health disparities. These root causes have been discussed little to date in relation to AD/ADRD, and thus, macrosystem influences, such as racism, classism, sexism, and homophobia, are the emphasis in this paper. Under Bronfenbrenner's macrosystem framework, we highlight key quantitative and qualitative studies linking S/SDOH with AD/ADRD, identify scientific gaps in the literature, and propose guidance for future research. Ecological systems theory links structural/social determinants to AD/ADRD. Structural/social determinants accrue and interact over the life course to impact AD/ADRD. Macrosystem is made up of societal norms, beliefs, values, and practices (e.g., laws). Most macro-level determinants have been understudied in the AD/ADRD literature.